March 11, 2020
His Excellency Charles D. Baker
Governor of the Commonwealth of Massachusetts
State House, RM 280
Boston, MA 02133
Dear Governor Baker:
As your declaration of a State of Emergency (Executive Order No. 591: Declaration of a State of Emergency to Respond to COVID-19) demonstrates, the novel Coronavirus 19 (COVID-19) has come to the Commonwealth and we are looking at a potentially unprecedented strain on health care resources. On behalf of the over 23,000 registered nurses and health care professionals we represent, I would like to provide you with the perspective of the frontline health care workers who are tending to potentially infected individuals as well as vulnerable patient populations. I also offer suggestions for actions that you and our health care facilities can take to mitigate the impact on patients, health care workers, and ease public fear.
What nurses are seeing
Despite the U.S. Department of Health and Human Services having declared the virus to be a nationwide health emergency following the World Health Organization’s (WHO) declaration of a public health emergency on January 30, 2020, nurses on the front-line are seeing numerous troubling trends:
- Health care facilities do not have enough Personal Protective Equipment (PPE) for frontline health care staff.
- Tests are not widely available.
- Potentially infected individuals are presenting at hospitals that are not equipped to triage, test, and properly treat them in an appropriate setting.
- Nurses are concerned about capacity to treat the potential influx of individuals with COVID-19. After years of closures of beds, units and hospitals, and reductions in frontline health care staff, hospitals lack the space and staff to deal with an unprecedented outbreak of this highly contagious virus. This puts patients, health care workers, and the general public at risk.
What should be done
The vantagepoint of frontline health care staff can provide valuable insight into how to mitigate the potential hazards associated with a COVID-19 outbreak.
- Halt all bed, unit and facility closures. As the guidance from the Department of Public Health (DPH) stated, “the surge in volume of patients with possible exposure to or symptoms of COVID-19 illness” could “overwhelm the capacity of emergency departments” (Circular Letter DHCQ 02-03-701). This is not a time to be eliminating capacity at our health care facilities. In the past two years, Massachusetts hospitals have moved to close emergency departments (Somerville Hospital, Lawrence Memorial Hospital and MetroWest Medical Center), close acute inpatient beds (MetroWest Medical Center), Intensive Care Units (Baystate-Noble Hospital) and close behavioral health beds (Providence Hospital, Baystate-Noble Hospital, Baystate-Franklin Medical Center). And while behavioral health beds may not be used for COVID-19 patients, the loss of these beds directly contributes to emergency department (ED) boarding, which the DPH advised hospitals to reduce or eliminate. This is in addition to the loss of hospitals in Quincy and North Adams since 2014. This is not the time to be reducing capacity.
- Halt all staff reductions. As with the physical capacity to care for patients with or suspected of having COVID-19, we need to be sure that we have enough health care staff to meet demand. Leominster Hospital is currently reducing its ED nurse staff. This is not the time to be eliminating frontline health care workers- specifically those in the ED.
- Protect frontline health care workers. Hospitals and other healthcare employers have the duty and responsibility to protect patients, and staff. This includes protecting workers from hazards posed by infectious diseases like COVID-19, and which measures will also limit the spread of the disease. Unfortunately, the CDC has chosen to weaken PPE standards. Massachusetts hospitals need to act to limit the number of staff triaging patients to help conserve the limited supply of PPE, and to provide all staff with proper PPE. Additionally, testing all staff with exposure to patients who test positive or who are triaging patients with COVID-19 symptoms.
- Designate specific areas to address suspected and confirmed COVID-19 cases. Isolating confirmed and suspected cases can stop the spread among patients and health care workers. Suggestions include: an anti-room triage, like the one created at Brigham and Women’s hospital to test individuals potentially exposed to COVID-19 at the Biogen conference; possibly designating one or two specific hospitals per geographic area as triage hospitals; designating a floor and an ICU specifically for COVID-19 patients or suspected patients.
- Prescreen all individuals presenting at Massachusetts hospitals. Prescreening all patients and visitors can help to reduce the spread of COVID-19 through a health care facility.
What not to do:
It has been called to our attention that proponents of Massachusetts joining the Nurse Licensure Compact have been pointing to the outbreak of COVID-19 as a reason to move quickly and enact this legislation. This is not a prudent course of action. Scare tactics like those used by proponents attempting to capitalize on a specific health event have no place in serious public policy discussions. Similar tactics were used following the Boston Marathon bombing and the Columbia Gas explosions, neglecting the fact that nurses flocked to hospitals following these events.
You didn’t fall for it then, don’t fall for it now. The current situation is not a reason for the Commonwealth to make a permanent decision to abdicate all nurse licensure responsibilities to a national entity in which you, as our elected leaders, will have no further say over the regulation of the single largest licensed health care workforce in the state. Heath care facilities and state government can take action to address any perceived short-term shortages should COVID-19 spread that do not necessitate joining the Nurse Licensure Compact. Also, having nurses from hospitals across the country quickly move into Massachusetts in the midst of this virus outbreak might contribute to the spread of COVID-19 rather than assist us in addressing it.
We are reaching out to hospitals and trying to work directly with them, but recognize the important role your office and state government have to play in mitigating the spread of COVID-19 while helping to manage the care of those who do become infected as well as the health care staff who treat them.
We will continue to be available as a resource as things progress, and we look forward to working together in service to the citizens of the Commonwealth.
Donna Kelly-Williams, RN
President, Massachusetts Nurses Association
Cc: Secretary MaryLou Sudders